[WSBARP] off topic query: how to help a client whose insurance company denied payment for prescribed services/treatment

[Carl L. Gay]

Dear Colleagues,

 

I subscribe to a medical listserve and someone posted the following “advice”
regarding what to do if an insurance company elects to deny payment for
doctor-ordered care. I am curious if any of you who is familiar with HIPPA
has been presented with such a situation and whether these steps have led to
success.  If this is an available remedy under HIPPA, I would think it could
be of great benefit to our clients. Thank you for your thoughts.

 

Best regards,

Carl Gay

 

 

Steps to take when health insurance company refuses to pay for prescribed
services/treatment.

 

Your doctor ordered a test or treatment and your insurance company denied
it. That is a typical cost saving method. OK, here is what you do:

 

1. Call the insurance company and tell them you want to speak with the
"HIPAA Compliance/Privacy Officer" (By federal law they have to have one).

 

2. Then ask for the Names as well as Credentials of everybody accessing your
record to make that decision of denial. By law you have a right to that
information.

 

3. They will almost always reverse that decision very shortly rather than
admit that the committee is made-up of low paid high school graduates who
are trained to look for "criteria words", making the medical decision to
deny your care. Even in the rare case it is made by medical personnel, it is
unlikely that it is made by a board-certified doctor in that specialty and
THEY DO NOT WANT YOU TO KNOW THIS.

 

4. Any refusal should be reported to the U.S. Office of Civil Rights
(OCR.gov) as a HIPAA violation.

 

 

CARL LLOYD GAY                 

GREENAWAY, GAY & TULLOCH

Attorneys and Counselors at Law                     

829 East Eighth Street       Suite A

Port Angeles, Washington   98362

Email                       <mailto:clgay at tfon.com> clgay at tfon.com

Telephone               (360) 452-3323


Facsimile                  (360) 452-3724 

 

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